​Recently we asked for a diabetes opinion for one of our patients. My colleague duly arrived and asked if we’d continued a medication I had no idea that the patient was on, or even which of the new groups of diabetes meds it belonged to. So I told him “I think so, yes” and snuck out of vision to check.

A recent opinion piece in BMJ careers argues that written reflection is ‘dead in the water’. I’d suggest you read it, but I personally disagree with most of it. I’ve tried to articulate my own counter-view in the five points below. What follows are my own beliefs, and I’d encourage you to leave a comment if (when?) you disagree.

Healthcare is a high risk and complex environment, and discussion of risk is emotive (take, for example, the headline chosen by the Times to put above a story making some effort to explain a fair blame approach).

​In trying to make sense of this this complex difficult and uncomfortable area however, one of the first steps must be to quantify and describe the risk.

Unplanned admissions to critical care would seem a reasonable place to look; sampling such cases for review is an accepted method that in an ideal world all critical care units would do in co-operation with the rest of the hospital.

One of our nurses always asks me for a Nicotine patch if she’s looking after a smoker.We always have the same discussion; how the 20ml/hr of Propofol is making it unnecessary and how Nicotine patches increase mortality.In reply she always tells me we wouldn’t need 20ml/hr Propofol if I treated the Nicotine withdrawal, and to stop being so awkward, uncaring and obnoxious (the last bit is implied by the ‘look’!).To try and reassure myself I’ve dug out the paper on which I base my mortality claim.It can be found here.